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Dec. 4 — Republicans are claiming victory as a result of Senate passage late Dec. 3 of legislation repealing much of the Affordable Care Act, including the Cadillac tax on high-cost health plans, and eliminating the financial penalty associated with the employer mandate.

The bill (H.R. 3762) was passed by a 52-47 vote using the reconciliation process, which meant it needed just 51 votes in the Senate, rather than the usual 60, to avoid a filibuster. The House now can either pass it as amended, or go to conference to work out the differences between the two versions before sending it to President Barack Obama, who has promised a veto. With the goal to send the bill to Obama as soon as possible, the House would likely pass the Senate version rather than create a conference committee.

Before final adoption, the Senate passed a substitute amendment to the House-passed legislation; the substitute amendment dramatically increased the scope of the ACA repeal. That amendment would in 2018 roll back the law's optional Medicaid expansion as well as the tax credits used to help people purchase health insurance. The measure also would repeal the 2.3 percent excise tax on medical devices and eliminate the financial penalties associated with the individual and employer mandates for health coverage.

The measure also would provide an additional $235 million for each of fiscal years 2016 and 2017 to the community health center program and restore Medicaid disproportionate share funding to hospitals that serve primarily low-income patients.

Numerous Amendments

Sens. Susan Collins (Maine) and Mark Kirk (Ill.) were the only Republicans to vote against the measure. They, along with Sen. Lisa Murkowski (R-Alaska), co-sponsored an amendment that would have stripped from the bill the language denying federal funds to abortion providers. However, the amendment failed, and the loss of two of the more moderate Republicans didn’t prevent the bill from clearing the body. Sen. Bernard Sanders (I-Vt.) was the only senator who didn't vote.

Aside from the Collins amendment, the Senate rejected dozens of others during the nearly seven hours of voting, including one from Democratic Sens. Patty Murray (Wash.) and Ron Wyden (Ore.) that would have stripped the abortion language to instead establish a fund that supported women's health and clinic safety. The amendment was defeated when senators voted 54-46 to set it aside.

In a rare moment of bipartisanship, senators adopted by voice vote an amendment that would permanently repeal the Cadillac tax on higher-cost health plans. The underlying legislation would have delayed implementation of the tax until 2025. The bipartisan inclusion of the Cadillac tax repeal could signal a willingness to address its repeal in other legislation.

Republican Praise

Senate Republicans praised the vote.

“By repealing Obamacare, we are doing more than just delivering on a promise. We are providing a way forward for millions of Americans around this country who have been hurt—not helped—but hurt by Obamacare,” Senate Majority Whip John Cornyn (R-Texas) said on the floor Dec. 3.

Orrin Hatch (Utah), chairman of the Senate Finance Committee, said in a Dec. 3 statement that Republicans “fulfilled our promise to end the negative consequences of Obamacare by repealing the President’s unaffordable health law. It’s now time the Obama Administration and Democrats own up to the law’s failures, reverse course, and work with Republicans to forge patient-centered reforms that reduce costs and improve care for the American people.”

On the chamber's floor, Senate Majority Leader Mitch McConnell (R-Ky.) called the vote a “victory for middle-class families.” He said the vote is a “bridge away from Obamacare and towards better care.”

Despite the promise of a veto, Republicans said the votes are important to show the public what a president representing their party would be able to accomplish in 2017.

“The vote in the Senate to put a repeal bill on the president's desk is a very important moment for the country,” Sen. John Barrasso (R-Wyo.) told reporters while the Senate was voting. Barrasso has been one of the leading voices in the Senate to repeal the ACA.

“This is a clear distinction between what the president is proposing and what Republican candidates would do,” he said. “This sends a message that we are committed to repealing this and replacing it with patient-centered care.”

‘Absurd' Vote

Democrats decried the amount of time Republicans have continued to spend attempting another repeal of the ACA, especially when the Senate has government funding deadlines looming the week of Dec. 7.

Senate Minority Leader Harry Reid (D-Nev.) called the vote “absurd.” During a Dec. 3 floor speech, Reid said “this Republican Congress is doing nothing to aid working American families. So instead of wasting everyone’s time, and instead of ignoring the wishes of people back home, let’s work together to improve health coverage. If Republicans would come to their senses, there are a lot of things that we can do together to improve health coverage for Americans.”

The White House said Obama would veto the measure because it would “take away critical benefits and health care coverage from hard-working middle-class families.”

“It’s a shame that Republicans wasted time on yet another attempt to repeal this law. Medicare is stronger and millions who had no insurance are now covered. Efforts to repeal this law need to stop,” Sen. Dianne Feinstein (D-Calif.) said in a statement. “It is also unbelievable that funding for Planned Parenthood, an essential health care provider, was attacked yet again. One in five women will use Planned Parenthood as their primary health care provider at some point in their lives.”

“The latest Republican political attack on families’ health care moved one step closer to a dead end,” Murray, the top Democrat on the Senate Health, Education, Labor and Pensions Committee, said in a Dec. 3 statement. “It is deeply disappointing that with workers and families rightly expecting us to focus on the many challenges our country is facing, Republican leaders chose to double down on pandering to the Tea Party by once again attempting to dismantle the Affordable Care Act and defund Planned Parenthood, our nation’s leading provider of women’s health care.”

To contact the reporter on this story: Nathaniel Weixel in Washington at nweixel@bna.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bna.com

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